How Does Isthmocele Affect Fertility and Pregnancy?

Isthmocele is a type of medical condition that many women might not be familiar with, but it can considerably affect women’s fertility and pregnancy in a major way. To put it simply, isthmocele is a pouch-like defect or scar in the lower segment of the uterus (either by surgical procedure, such as a cesarean section, or as a medical complication of childbirth).  

This pocket or indent is small but is significant when it comes to problems related to bleeding, pain, and, perhaps most importantly, keeping or even conceiving a pregnancy.  

In this article, we will summarise isthmocele, its symptoms, causes, effects on fertility and pregnancy, and treatment options. 

What Causes Isthmocele?  

The primary causes of isthmocele are associated with previous uterine surgery, particularly cesarean sections. With a cesarean delivery, the surgeon cuts through the patient’s uterine wall tissue. In some cases, the healing process post-surgery does not occur correctly, and a weak area (defect) in the uterine muscle heals improperly, and tears form an isthmocele. Factors that may increase the likelihood of isthmocele are: 

• Poor surgical technique during C-section  
• Multiple cesarean deliveries  
• Infection or inflammation during healing  
• Use of certain stitches that don’t heal well  

Other less common causes include myomectomy (removal of fibroids) or any surgery involving the lower uterus.  

Symptoms and Diagnosis of Isthmocele  

Many women with isthmocele may not have clear symptoms, but some do experience discomfort or changes that signal a problem. Common isthmocele symptoms include:  

• Abnormal vaginal bleeding, especially spotting between periods or after sex  
• Pelvic pain or discomfort  
• Painful periods  
• Infertility or difficulty conceiving  
• Feeling of pelvic pressure  

Because these symptoms can overlap with other conditions, doctors use imaging tests to diagnose isthmocele accurately.  

How Isthmocele Affects Fertility  

One of the most concerning aspects of isthmocele is its relationship with isthmocele and infertility. Women struggling to get pregnant may have an undiagnosed isthmocele affecting their chances. Here’s how: 

a. Impact on Sperm Migration

The pouch created by the isthmocele can collect old blood and mucus. This accumulation creates an unfavorable environment that can block or slow down sperm as they try to reach the egg. Thus, sperm migration may be impaired, reducing the likelihood of fertilization. 

b. Effects on Implantation

After fertilization, the embryo needs a healthy uterine lining to implant and grow. The scar tissue and inflammation from an isthmocele may alter the endometrial environment, making it harder for the embryo to attach properly. 

c. Risk of Miscarriage

Even if implantation occurs, an isthmocele may increase the risk of early pregnancy loss. The defective scar may cause poor blood flow or unstable attachment sites, contributing to miscarriages.  

How Isthmocele Affects Pregnancy  

If pregnancy occurs despite an isthmocele, certain risks remain: 

a. Risk of Ectopic Pregnancy

Rarely, the abnormal uterine scar can increase the chance of an ectopic pregnancy, where the embryo implants outside the uterus. This is a dangerous condition requiring immediate medical attention. 

b. Placental Abnormalities

Women with isthmocele may experience problems like placenta previa (placenta covering the cervix) or placenta accreta (placenta growing too deeply into the uterine wall). These conditions can cause bleeding and complications during pregnancy and delivery. 

c. Uterine Rupture Concerns

Since an isthmocele indicates a weak spot in the uterus, there is a small but serious risk of uterine rupture during pregnancy or labor. This risk is higher if the scar is large or the woman has had multiple C-sections.  

Diagnosis Methods for Isthmocele  

Doctors use several tools to detect an isthmocele: 

a. Ultrasound

A transvaginal ultrasound is often the first test. It helps visualize the uterine scar and identify any pouch or defect. Sometimes, saline infusion sonohysterography (injecting fluid into the uterus during Ultrasound) is used for clearer images. 

b. Hysteroscopy

This involves inserting a small camera through the cervix into the uterus to directly view the scar defect and assess its size and depth. 

c. MRI Evaluation

Magnetic resonance imaging (MRI) can provide detailed images and is useful in complex cases or when other tests are unclear.  

Treatment Options for Isthmocele  

Treatment depends on the severity of symptoms and the desire for future pregnancy. 

a. Surgical Interventions

Surgery is the most effective way to repair an isthmocele. It can be done using minimally invasive methods such as laparoscopy or hysteroscopy. The surgeon removes the scar tissue and repairs the uterine wall to restore normal shape and function. 

b. Non-Surgical Management

If symptoms are mild and fertility is not a concern, doctors may recommend hormonal treatments or careful monitoring. Sometimes, symptom relief is the primary goal. 

c. Fertility Treatment Considerations

For women with isthmocele and infertility, fertility treatments like in vitro fertilization (IVF) may be considered after repair surgery. Proper healing improves the chances of a successful pregnancy.  

When to Consult a Doctor?  

You should see a doctor if you experience unusual vaginal bleeding, pelvic pain, or have difficulty getting pregnant, especially if you have had a previous C-section. Early diagnosis and treatment of isthmocele can prevent complications and improve fertility outcomes.  

Conclusion  

Isthmocele is a condition that can quietly affect a woman’s reproductive health, especially after a cesarean delivery. Understanding its causes, symptoms, and impact on fertility and pregnancy helps women seek timely care. With proper diagnosis and treatment, many women with isthmocele and infertility can go on to have successful pregnancies. To understand more, discuss with the fertility specialists from the  Oasis Fertility Clinic near you. You can also contact us on 1800-3001-1000 or use our live chat option for prompt assistance.     

FAQs on Isthmocele  

Can you have a successful pregnancy with an isthmocele?

Yes, many women with an isthmocele can have successful pregnancies, especially after treatment to repair the uterine defect.  

How do you fix isthmocele?

Isthmocele is usually fixed through surgery, either by laparoscopy or hysteroscopy, where the scar tissue is removed and the uterus is repaired.  

What is the recovery time for isthmocele repair surgery?

Recovery typically takes a few weeks, but it varies depending on the surgery type. Doctors usually advise waiting a few months before trying to conceive again